December 2019 marks one hundred years since the introduction of the Nurses’ Registration Act – an Act which introduced a compulsory register for professional nurses. It was instrumental in both increasing patient safety and also in regulating and standardising the nursing profession.
This Act was the product of a long campaign led by Ethel Gordon Fenwick, a nurse and political campaigner who devoted over thirty years of her life to fight for the introduction of a nurses’ register.
Ethel Gordon Manson was born in Elgin in Scotland in 1857 but was raised in Thoroton, Nottinghamshire. She began her children’s nurse training at Nottingham Children’s Hospital in 1878 and went onto train as an adult nurse at the Manchester Royal Infirmary in 1879.
In 1881, at the age of just 24, she became the matron at St Bartholomew’s Hospital, one of the most influential and oldest in London. She remained the matron until 1887 when she had to leave her post because she married Dr Bedford Fenwick and became Mrs. Bedford Fenwick.
The fight for registration
Following her marriage, Mrs Bedford Fenwick stopped practising as a nurse and began what would become a thirty-two year campaign for the introduction of a compulsory nurses’ register. This involved Mrs Bedford Fenwick and her fellow campaigners waging a political campaign at a time when women did not have the right to vote.
She devoted her life to fighting for a cause which she believed would advance the nursing profession. She founded the British Nurses’ Association (BNA) in 1887 (an organisation which acquired royal patronage and became the Royal British Nurses’ Association in 1893) and acquired and became the editor of The British Journal of Nursing in 1903. Both the RBNA and the journal were instrumental in her campaign for the introduction of the nurses’ registration.
The length of the campaign alone is indicative of the difficulty Fenwick and her fellow campaigners had in introducing a nurses’ register. The entire process was dogged by internal disagreements within the RBNA over registration, and between the RBNA, The Matrons’ Council for Great Britain and Ireland, and The College of Nursing.
Rival parliamentary bills were drafted by the RBNA and The Society for the State Registration of Nurses. Mrs Fenwick’s campaign also faced resistance from anti-registrationists such as Eva Luckes of The London Hospital, who appear to have had the tacit approval of Florence Nightingale.
At the same time, most Hospital Authorities and Boards of Governors were concerned that registered Nurses would be more costly than unregistered hospital staff. Despite this, the Act was finally passed in 1919 and Fenwick was the first to sign it becoming “State Registered Nurse No.1” in 1921.
The register was held initially by the General Nursing Council, which later became the United Kingdom Central Council and is now known as the Nursing and Midwifery Council.
Why the Nurses’ Registration Act is important
The Act made registration compulsory for all nurses. Initially an aspiring nurse would have to be over the age of 21; be able to provide three references of good character and demonstrate that they had at least one years’ training and two years’ subsequent practice. For the first time the Nurses’ Registration Act introduced regulation to the nursing profession and set standards for practice that all nurses had to adhere to.
Before the Act was passed, anyone could call themselves a nurse irrespective of whether they had received any professional training. This unregulated system was problematic as it put both nurses and patients at risk.
When giving evidence to a Parliamentary Select Committee in 1905, Mrs Fenwick provided one notable example of how an unregulated system allows bad nurses to practice. She told the story of one nurse who had tried to poison a Sister at St Bartholomew’s Hospital. Instead of being disciplined or tried in criminal court, the nurse was instead quietly dismissed and was able to find a new job at a nursing institute in Sheffield where she was accused of poisoning a patient.
Later, similar incidents occurred at the Manchester Royal Infirmary where the nurse transferred under a false name. The nurse was eventually interviewed by a committee and was dismissed but never prosecuted.
Mrs Fenwick believed that by standardising the nursing profession, the Nurses’ Registration Act would remove “bad nurses” and make health care safer for patients.
By setting standards, The Nurses’ Registration Act introduced professionalism to nursing, elevating it to the position of an exclusive learned profession and set training precedents which continues today.
Alongside fighting for registration, Mrs Fenwick was a campaigner on the international stage. She was one of the founders of the International Council of Nurses in 1899. This organisation united nurses from across the world to advance the status of the profession internationally.
Mrs Fenwick was also a supporter of the suffrage movement and would frequently devote columns to the cause in the British Journal of Nursing whilst she was the editor. She enjoyed writing and in 1910 she was elected President of the Society of Women Journalists.
Ethel Gordon Fenwick’s legacy
Despite her important work and its long lasting legacy, Ethel Gordon Fenwick has sadly fallen into obscurity with few nurses remembering her work. Those who are aware of her achievements suggest that her contributions to nursing are as significant as Florence Nightingale’s.
Unlike Nightingale who has been immortalised by statues in Westminster and Derby, Mrs Fenwick is far from being a household name and sadly her grave in Thoroton is in a state of disrepair.
As nurses celebrate the centenary of the introduction of the nurses’ register later this year, it is important to reflect on Mrs Fenwick’s significant contributions to the development of nursing as a
The current nursing regulatory body, the Nursing and Midwifery Council, defines standards and ensures nurses continue to meet these in their daily practice, a precedent which began with the
Nurses’ Registration Act.
James Shepherd is part of the Ethel Gordon Fenwick Commemorative Partnership, a group which seeks to raise the profile of the former nurse and political campaigner.